Eastern Cardiothoracic Surgical Society

Comparative Outcome Analysis of Minimally Invasive Ivor Lewis and Open Transhiatal Esophagectomy
Mark Crye, Mathew Van Deusen, Frances Philip, Rodney J. Landreneau, Blair Jobe, Lana Y. Schumacher,  Allegheny Health Network, Pittsburgh, PA


OBJECTIVE: Esophageal resection and reconstruction remains a mainstay of treatment with curative intent for esophageal cancer. The open transhiatal approach has been the mainstay of surgical resection within our system prior to the adoption of the minimally invasive Ivor Lewis (MIE) approach in recent years. We sought to evaluate the outcomes from out system to determine if there is a detrimental effect to patient outcomes by entering the chest cavity.

METHODS: A retrospective review of prospectively collected data utilizing the STS database from January 2009 through May 2016. Patients undergoing either MIE or open transhiatal esophagectomy from 2009-2016 were evaluated. Data collected and analyzed included: demographics, comorbidities, operative time, length of stay, in hospital and 30 day mortality, and post operative complications.

RESULTS: Demographic data, comorbidities, and utilization of neoadjuvant therapy were equivalent between the two groups. In house and 30 day mortality in both groups were comparable, as were overall morbidity and pulmonary complications. Anastomotic leak rate trended higher for MIE, but did not reach statistical significance. Operative time, ICU and Hospital length of stay all were significantly longer in the MIE group. (Table SA2-1)

CONCLUSIONS: This retrospective review shows that the incidence of pulmonary complications associated with the MIE approach is not significantly different than those seen in the transhiatal approach. The leak rate trended higher in MIE, which is seen in other published data. Evaluation of length of stay and operative time may help improve these to levels comparable to our transhiatal results.

Table SA2-1
Patient Demographics and Outcomes for Open Transhiatal
and Minimally Invasive Ivor Lewis Esophagectomy

  Transhiatal (n=56) MIE (n=70) p-value
Age (mean, std deviation) 64.9 +/- 11.6 63.6 +/- 10.1 0.5
Sex (male/female) 89%/11% 84%/16% 0.5
Neoadjuvant chemo/XRT 24 (42.9%) 35 (50%) 0.47
Operative Time (min) 237.9 +/- 84.3 391.1 +/- 89.7 <0.05
Mortality- In House 1 (1.8%) 2 (2.9%) 1
                                        30 Day 2/53 (3.8%) 2/58 (3.4%)  
Pulmonary Complications 12 (21.4%) 20 (28.6%) 0.41
Anastomotic Leak 4 (7.1%) 13 (18.6%) 0.07
Length of Stay (ICU/Overall, days) 5.4 +/- 7.6   //    10.5 +/-7.8 6.8 +/-7.5   //    13.9 +/-9.1 <0.05